Gustilo-Anderson Classification of Open Fractures

Type	Wound	Contamination	Soft Tissue Damage	Bone Damage
I	<1cm	Clean	Mild	Simple, mild comminution
II	>1cm	Moderate	Moderate, partial muscle damage, no skin avulsion	Moderate comminution
III	Extensive soft tissue damage including skin or flap lacerations, segmental fractures, severe contamination, injury duration over 8 hours, and any injury requiring vascular repair, divided into the following 3 subtypes:
A	Generally >10cm	Severe	Severe, with crushing	Mostly comminuted, but soft tissue can cover fracture ends
B	Generally >10cm	Severe	Severe soft tissue loss, periosteal stripping, requiring soft tissue reconstruction	Poor fracture coverage, varied, may have moderate to severe comminution
C	Generally >10cm	Severe	Very severe soft tissue loss with vascular injury requiring repair or open joint dislocation	Poor fracture coverage, varied, may have moderate to severe comminution

Explanation

The Gustilo-Anderson classification is one of the most commonly used methods internationally. Anderson initially classified open fractures into three types based on the extent of soft tissue damage. In 1984, Gustilo identified limitations in this classification during clinical application and further divided Type III into three subtypes: A, B, and C.

Open fractures are characterized by the fracture ends being exposed to the external environment, resulting in wound contamination. Open fractures often result from high-energy injuries, leading to severe bone and soft tissue trauma, poor healing environments, and reduced resistance to bacterial proliferation.

References

1. Gustilo RB, et al. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984;24(8):742-6.

2. Chapman MW. The role of intramedullary fixation in open fractures. Clin Orthop Relat Res. 1986;(212):26-34.

3. Chen Xiaoping, editor. Surgery (Eight-year system) (2nd edition). People's Medical Publishing House. 2010. p910.